HRSA's Patient Safety

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HRSA's Patient Safety Clinical Pharmacy
Services Collaborative An Update on this Bold
National EffortJune 25, 2008BPHC All-Grantee
Meeting Preparation for Team Submission of
Participation Package

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Overview

• Sue Sheridan Video Call to Action
• Overview of the Patient Safety and Clinical
  Pharmacy Services Collaborative (PSPC)
• Denise Geolot, Director, HRSA Center for Quality
• Jimmy Mitchell, Director, Office of Pharmacy
  Affairs
• How will the PSPC work?
• Krista Scardina, Office of Pharmacy Affairs
• Rebecca Hines, Office of Planning and Evaluation
• Ahmed Calvo, Center for Quality

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Questions We Are Running On

• What can local community organizations do to
  align with, benefit from, and support this work?
• How can HRSA Grantees and other organizations
  partner with HRSA, national organizations, and
  state organizations in leading this work?
• What opportunities are there for further
  leadership and involvement down the road in this
  collaborative?

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Operational Key Question for this Session
What can each of us do to help enroll local
community teams into the Patient Safety and
Clinical Pharmacy Services Collaborative (PSPC)
by July 1, 2008?
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Why a Patient Safety Clinical Pharmacy
Collaborative?

• HRSA is committed to supporting programs to
  provide the best and safest care in the Nation
• HRSA has supported multiple Learning
  Collaboratives and has documented improvements
  gained through these rapid improvement
  methodologies
• Pharmacy services in HRSA programs safety-net
  partners are growing rapidly

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Why are we doing this work?

• Increase in multiple chronic conditions
• Alignment with HRSA Core Measures
• ADEs leading cause of death and injury IOM
  Report
• Aging population polypharmacy
• Lack of integration of clinical pharmacy services
• Lack of coordination for patient transitions

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Institute of Medicine Findings on Patient Safety
and Errors

• Medication Errors are Most Common
• Injure 1.5 Million People Annually
• Cost Billions Annually
• for every dollar spent on ambulatory
  medications, another dollar is spent to treat new
  health problems caused by the medication.

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HRSA Pharmacy Programs

• Pharmacy services in HRSA programs safety-net
  partners are growing rapidly
• 5,000,000,000

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Growth of Section 340B Covered Entity Sites
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HRSA Core Measures

• Prenatal First Trimester Care
• Cancer Screening Breast Cancer Cervical
  Cancer Colorectal Cancer
• Diabetes- A1C
• Immunizations
• Cardiovascular- Hypertension
• HIV Prenatal Screening Test

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Patient Safety Clinical Pharmacy
Collaborative Goals

• Improve Health Outcomes by focusing on
  implementing effective patient safety principles
  and clinical pharmacy services
• Improve Patient Safety
• Increased Compliance w/ NQF Guidelines
• Fewer Errors, Fewer Injuries, Less Harm
• Possible Reductions in Size Number of Tort
  Claims
• Increase High Quality, Cost-Effective Pharmacy
  Services

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What are Clinical Pharmacy Services?

• Patient-centered services that promote the
  appropriate selection and utilization of
  medications to optimize individualized
  therapeutic outcomes
• Provided by an inter-disciplinary healthcare team
  through individualized patient assessment and
  management
• Services best provided by a pharmacist or by
  another healthcare professional in collaboration
  with a pharmacist

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Patient Safety Pharmacy Collaborative
Patient
Optimum Health Outcomes
Integrated Patient Care
Clinical Pharmacy Services
No Adverse Events
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Patient Safety and Clinical Pharmacy
Services Collaborative
Patient Safety
Clinical Pharmacy Services
Integrated Patient Care Services
QUALITY
Health Outcomes
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PSPC Game Plan

• Partner with state and national organizations to
  support teams
• Create knowledge package
• Align aims, practices and measures with existing
  guidelines
• Use collaborative action learning model

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Our Collaborative Process
Select Topics
Enroll Teams
LS 1 August 1415, 2008
Study High Performers
Action Period
LS 2 Early Dec. 2008
Create Change Package
Action Period
LS 3 April, 2009
IdentifyFaculty
Action Period
LS 4 Fall 2009
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Key Players

• HRSA Leadership, Bureaus and Offices
• Faculty Leader/Practitioners and HRSA Team
• Leadership Coordinating Council of National
  Partner Organizations
• State-Based Organizations
• all supporting
• Frontline Caregivers and Administrators on
  Collaborative Teams

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Leadership Coordinating Council

• National organizations who care about patient
  safety, pharmacy and/or healthcare for the
  underserved.
• who are meeting and teaming to figure out what
  each of them can do to help Collaborative Teams
  to succeed.

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Who are some of our emerging national partners?

• ASHP CMS AHRQ
• APhA NACDS Joint Commission
• NRHA IHI Heinz Foundation
• ANA ISMP NACHC
• USP PQA ACU
• FDA CDC AANP
• Apexus/Prime Vendor Program NASTAD
• and Many Others

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Group Discussion and Processing

• What benefits does the PSPC create for your
  organization?
• What excites you about this effort?

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• The Change Package

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• What do we do with all of our learning?
• What are the leading practices being used by high
  performing providers?
• We bring together common themes in a Change
  Package

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What is a Change Package?

• Menu of Promising Action Items for Testing and
  Adapting for Use by Teams in Their Home Settings

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Whats In a Change Package?

• Strategies
• Plans for Achieving an End System-Wide
  Improvement
• Change Concepts
• Approaches Found to Be Useful in Developing
  Specific Ideas for Changes That Lead to an
  Improvement
• Action Steps
• Specific Ideas to Implement Each Change Concept

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What Forms the Basis for the Change Package?

• Existing Research Literature
• Leading Practices of High Performers
• Expert Panel
• Experiences of Collaborative Teams

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Key Framing Questions

• What are the successful practices that high
  performing providers are using?
• What do they look like in practice?
• Who can articulate and project these practices
  with clarity and power?

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Strategies What Weve Learned

• Leadership Commitment
• Develop organizational relationships that
  promote safe medication-use systems and optimal
  health outcomes
• Measurable Improvement
• Achieve change using the value and power of
  data- driven improvements
• Integrated Care Delivery
• Build an integrated health care system across
  providers and settings that produces safety and
  optimal health outcomes
• Safe Medication Use Systems
• Develop and operate by safe medication-use
  practices
• Patient-Centered Care
• Build a patient-centered medication-use system

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Strategy
Integrated Care Delivery
Change Concept
Develop an integrated multi-professional care
team that includes clinical pharmacy services
Action Items

• Establish trust and good communication among the
  participating providers by creating a standard
  protocol for collaborative practice agreements
  for clinical pharmacy services within and across
  organizations
• Promote internal collaborations to build teamwork
  among nurses, physicians, pharmacists, and other
  providers

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The Work of the Collaborative

• Create Expectation That Each Team Begins by
  Addressing a Change Concept Under Each Strategy
• Use the Improvement Model (Plan/Do/Study/Act) to
  test specific actions in their environment
• Action Period Between Learning Sessions

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High-Performer Outcomes
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Dimensions of the Change Package

• Strategies/Change Concepts/Action Items
• Major Locus of Change
• A coalition of providers that joins the
  Collaborative as a Team
• Introduced and led by a faculty of their peers
• Drawn from the field
• Articulate leading practices that get results

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Whats Next

• Enroll teams in the PSPC Due July 1, 2008
  (1159 pm EDT)
• Pre-Work starts of July 15, 2008 (two calls
  tentatively planned for July 22 and July 30)
• First Learning Session - August 14 - 15, 2008
  (Gaylord Hotel, Washington DC Metro Area)

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Who will join?

• Teams of providers from multiple local caregiver
  organizations in a community who want to improve
  the quality and safety of care for a defined
  patient population they together serve
• Health Centers
• Rural Health Clinics
• Critical Access Hospitals
• Disproportionate Share Hospitals
• Community Pharmacies
• HIV AIDS Clinics
• Others (inclusivity is encouraged)

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Teams of Providers like..

• Clinical pharmacists
• Nurses
• Doctors
• Other primary care clinicians
• QI staff
• Administrators
• Senior Leaders

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Team Configuration Examples

• CHC Disproportionate Share Hospital Rural
  Health Clinic Community Pharmacy
• HIV Clinic Critical Access Hospital Womens
  Health Clinic
• Multiple CHCs Disproportionate Share Hospital
  and their associated clinics
• Rural Health Clinic Hospital School/College
  of Pharmacy

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Team Configuration Examples

• Many Others

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Care Transitions and Handoffs
Hospital Inpatient
Patient Multiple Conditions
Hospital ED
Primary Care Home(s)
Specialist
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Care Transitions and Handoffs
Hospital In Patient
Patient Multiple Conditions
Hospital ED
Primary Care Home(s)
Pharmacy Services
Specialist
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Care Transitions and Handoffs
Hospital In Patient
Patient Multiple Conditions
Hospital ED
Conditions For A Disaster
Primary Care Home(s)
Pharmacy Services
Specialist
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Care Transitions and Handoffs
Patient
Hospital In Patient
Multiple Conditions
Hospital ED
Patient Self- Management
Primary Care Home(s)
Pharmacy Services
ClinicalPharmacy Services
Specialist
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Target patient populations that have the
following high risk characteristics

• One or more chronic conditions
• Encounters with multiple service providers where
  prescriptions can be written
• Use of high risk medications (e.g., warfarin and
  insulin)
• Use of multiple medications
• Poor patient medication control and
  self-management or low health literacy

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What will the teams do?

• Commit to Collaborative aims
• Commit time and effort
• Designate consistent members to attend all 4
  Learning Sessions and support travel
• Measure and track progress
• Share activities and results
• Align with team around continuity of care
• Bring their organizations senior leader(s) to
  Learning Session 2

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Timelines for Participation

• Released May 15th
• Deadline to submit materials July 1st
• Team prework begins July 15th
• First Learning Session August 14 15 in the
  Gaylord Hotel, Washington, DC Area

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Questions to Run On

• What are the benefits to those who join the
  Patient Safety and Clinical Pharmacy
  Collaborative?
• What is the unique value proposition for those
  who join this collaborative? 

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Key Benefits of Participation in the PSPC

• Its the Right Thing to Do for the Patients We
  Serve
• Safer
• More, Better Pharmacy Services
• Improved Health Outcomes
• Reduces/Manages Risk and Risk is Increasing
• Builds on and Takes Prior Experience to a New
  Level
• Integrated
• Takes HRSA Collaborative Experiences to the Next
  Power

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Key Benefits of Participation in the PSPC

• Integrates Services to Maximize Community Health
• Reduces Inappropriate Use of Polypharmacy
  Better Medication Management
• Will Help Create New Partnerships Synergies
  Across Provider Organizations
• Exposure to Cutting Edge People and Methods on
  Quality Improvement, Leadership Change
  Management
• Chance to Be A Part of a Major National Movement
  in a Rewarding All Teach, All Learn Environment

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Value Proposition

• Organizations can achieve better health outcomes
  for patients through safer, integrated clinical
  pharmacy services.

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Value Proposition

• System improvements in pharmacy will improve
  outcomes for your patients across a broad range
  of chronic conditions.
• were ready to go beyond improvements one
  disease at a time!

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What are some of the ways that State
Organizations might help lead on the PSPC?

• Helping Teams Get Ready for LS 1
• Convening State-wide Learning Sessions in
  December and Spring, 2009 to match up with the
  national learning session --- downloading
  satellite feed of presenters (for example).
• Modeling Cross-Organization Collaboration

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Patient Safety and Clinical Pharmacy Services
Collaborative (PSPC)

• Communication
• HRSA Website
• www.hrsa.gov/patientsafety
• Questions?
• patientsafety_at_hrsa.gov
• HRSA Knowledge Management System
• www.healthdisparities.net
• National Leadership Series Calls PSPC Calls
  stored in KMS library Dec 19, 2007, Apr 9, 2008,
  May 8, 2008, May 28, 2008, and June 4, 2008

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Knowledge Management

• Web Address www.healthdisparities.net
• Virtual Office and List-serv functionality
• Virtual Office Patient Safety and Pharmacy
• Increased sharing of tools and resources
• Expanding Knowledge Base and Library
• Contact for assistance Fred Butler
  fbutler_at_hrsa.gov

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National Leadership Series PSPC Pre-Work

• July 22 -- 12 Noon to 1 PM EDT
• Pre-Work in preparation for LS1
• July 30 -- 12 Noon to 1 PM EDT
• Pre-Work in preparation for LS1

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Patient Safety Clinical Pharmacy Collaborative
Next Steps??

• Share the information with potential partners
• Engage with community partners
• Engage your senior leaders in the vision
• Secure support for participation
• Review participation package
• Ask questions
• Apply with your teams to participate
• What are you waiting for??

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Group Discussion and Processing

• What will you do back home to engage with others
  in your community?
• What requests and offers will you make that can
  help you succeed with this work?

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www.hrsa.gov/patientsafety patientsafety_at_hrsa.g
ovwww.healthdisparities.net IHI Breakthrough
Series White Paperhttp//www.ihi.org/IHI/Result
s/WhitePapers/TheBreakthroughSeriesIHIsCollaborat
iveModelforAchievingBreakthroughImprovement.htm